Síndrome coronario agudo durante la gestación

Acute coronary syndrome in women aged less than 40 years old is uncommon and is even less frequent during pregnancy. However, the incidence of this syndrome can be expected to increase because associated risk factors, such as increased age at pregnancy, are becoming increasingly frequent.     

Trombosis del seno venoso cerebral en gestante con síndrome de Job

Cerebral venous sinus thrombosis is uncommon. Pregnancy is a major risk factor for the development of this entity. We report the case of a patient with Job’s syndrome and protein C and S deficiency who developed cerebral venous sinus thrombosis and dural fistula at 36 weeks’ gestation. After heparinization, the treatment of choice, pregnancy termination to eliminate the prothrombotic status and embolization of the dural fistula were required to obtain complete remission of the neurological symptoms.     

Enfermedad de Paget de la mama y síndrome de Rokitansky. Una excepcional asociación

We present the case of a woman with Rokitansky syndrome who developed Paget's disease of the breast at the age of 70 years. This is the first report in the literature of the simultaneous association of these two diseases.     

Prevención de la hemorragia posparto en una gestante afectada de síndrome de Hermansky-Pudlack

Hermansky-Pudlak syndrome is a multisystemic disease with autosomal recessive inheritance, mainly characterized by oculo-cutaneous albinism and impaired platelet aggregation. We describe the follow–up and end of pregnancy in a 30-year-old woman with this syndrome, as well as the measures carried out during labor to avoid bleeding complications due to platelet dysfunction. The pregnancy ended at 38.2 weeks through vaginal delivery, without epidural anesthesia and good maternal and fetal outcome.     

Aneurisma esplénico complicado durante la gestación

The splenic artery is the third most common site of abdominal aneurysms, only preceded by aortic and iliac aneurysms. The real prevalence is unknown but autopsy studies have described a prevalence of 0.01% to 10.4%, and these aneurysms have been found in 0.78% of angiograms. Splenic artery aneurysms occur in 7.1% of patients with cirrhotic portal hypertension. Atherosclerosis is rarely the primary cause, which is usually the result of degeneration of the middle arterial layer.     

Disección aórtica aguda tipo A en gestante de 33 semanas afectada del síndrome de Marfan

Although aortic dissection is uncommon in young women, it occurs more frequently during pregnancy, especially in the last trimester. Predisposing factors for aortic dissection are Marfan syndrome and other collagen diseases, chronic hypertension, aortic coarctation and cocaine abuse.     

Teratoma inmaduro de ovario en la gestación

Ovarian tumors are estimated to occur in about 1 in 1000 pregnancies; of these, 3% are malignant. Most patients are clinically asymptomatic and the masses are usually detected in a routine abdominal examination during the second trimester of pregnancy. The management of these ovarian masses depends on their etiology and clinical findings. Surgical intervention is required when malignancy is suspected. Neoadjuvant chemotherapy is also indicated. Fertility conserving surgery should be attempted.     

Agenesia lumbosacra. Expresión del síndrome de regresión caudal

Lumbosacral agenesis is an uncommon condition which is part of the caudal regression syndrome.     

Manejo conservador de un hematoma subcapsular hepático en un síndrome de HELLP

To improve morbidity and mortality in patients with subcapsular liver hematoma, clinical suspicion, a rapid diagnosis and multidisciplinary treatment are fundamental. The treatment of this complication includes expectant management with clinical and radiological observation, embolization of the hepatic arteries, and surgical treatment if there is hemodynamic instability, persistent bleeding or increasing pain. We report a case of postpartum HELLP syndrome that was complicated by a subcapsular liver hematoma, successfully treated by embolization of the right hepatic artery.     

Púrpura trombótica trombocitopénica versus síndrome de HELLP: un reto diagnóstico durante la gestación

Thrombocytopenia is relatively frequent during pregnancy and can occur in a range of syndromes. Among these, particular attention should be paid to thrombotic thrombocytopenic purpura (TTP) and HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count). It can be difficult to differentiate between these conditions during pregnancy, and their management and complications may differ widely. It is therefore essential to recognize their causes and perform a correct differential diagnosis, particularly in light of their possible serious consequences, which include maternal and/or fetal death.     

Síndrome de Ogilvie: una complicación poscesárea

Ogilvie's syndrome is acute colonic pseudo-obstruction without mechanical obstruction, is a tipical complication of caesareas and hips surgery. It is difficult to diagnose, mainly, by having clinic similar to paralytic ileus, but with a much higher gravity. Its complications are ischemia and perforation, which can have when establishing a mortality rate of up to 50%. This is a case with bad evolution after caesarea and that despite the medical treatment is complicated with cecal perforation, finishing in a right hemicolectomy.     

Inseminación artificial intrauterina en mujeres con síndrome de ovario poliquístico resistentes al citrato de clomifeno

Objective

To evaluate the results of ovulation induction cycles with gonadotropins and intrauterine insemination (IUI) carried out in women with polycystic ovary syndrome (POS) resistant to clomiphene citrate.

Material and methods

We performed an observational retrospective study of 462 ovulation induction cycles with IUI in women with SOP and clomiphene citrate resistance.

Results

The clinical pregnancy rate was 11.9% per cycle initiated and 14.74% per insemination and 45.45% of the pregnancies terminated in abortion. The effective accumulative percentage of term pregnancies per cycle initiated was 8% for the first cycle and 10.23% for insemination, increasing to 26.15% from the fifth cycle and to 32.24% from the fifth insemination. A total of 19.26% of the cycles was cancelled.

Conclusions

IUI is a useful method in women with SOP who are resistant to clomiphene citrate, with similar results to those obtained with other indications. These patients have high abortion and cycle cancellation rates. The high abortion rate should prompt research into ways of reducing reproductive loss.     

Hiperemesis gravídica complicada con síndrome de Korsakoff

Hyperemesis gravidarum is seen as the most serious form of vomiting during pregnancy. It was described in the medical literature in the 18th century as a cause of maternal death due to starvation, a not uncommon event until the 20th century. Nowadays maternal death is unusual.     

Cribado combinado del síndrome de Down: validación del riesgo estimado por Fetaltest

Objective

To validate empirically the risk for Down syndrome estimated by Fetaltest using biochemical markers in the first trimester (PAPP-A and free beta subunit of hCG) and nuchal translucency.

Material and methods

We performed a retrospective study of the data from 15,009 pregnant women screened for Down Syndrome in the first trimester, included in the database prospectively maintained by the Fetaltest multicenter study, and completed before December 31, 2007. The study included 39 cases of Down syndrome detected either prenatally or postnatally, and used a previously established analysis method.

Results

The correlation between predicted risk and the observed prevalence of Down syndrome was very high (r = 0.999967).

Conclusions

The risk estimated by Fetaltest agrees closely with the observed prevalence of Down syndrome. Therefore, this calculation system is valid and can be used with confidence when counseling pregnant women in our environment.     

Feto acardio en gestación gemelar monocorial biamniótica. Síndrome de perfusión arterial inversa gemelar

Multiple gestations involve an exacerbation of the signs and own symptoms of the pregnancy, and suppose a situation of risk for the mother as for the fetuses.One of these complications is the twin reverse arterial perfusion (TRAP), a very rare process (1% of the multiple gestations) or 0,3/10000 borned alive, that consists of the coexistence of a normal fetus (called “pump”) and an acardiac fetus.The abnormal fetus, displays, in most of the cases, incomplete development of the cephalic pole, heart, superior members and numerous organs. The lower members are relatively well conserved although the foot is usually bad conformed as well as the anomalies in the toes are frequent. Is frequent the edema in superior half of the fetus.We displayed an agreed case about this matter occurred in our hospital.     

Complejo Dandy-Walker asociado a síndrome polimalformativo

Dandy-Walker complex is a sporadic congenital malformation of the midbrain dysmorphogenesis that involves a variable degree of anatomical abnormalities mainly in the cerebellum and fourth ventricle. This syndrome can be associated with other malformations.     

Gonadoblastoma bilateral y disgerminoma asociados en un síndrome de Swyer

Swyer syndrome is a pure gonadal dysgenesis with female phenotype and 46 XY karyotype. Affected individuals have dysgenetic and non-functioning gonads. The risk of gonadal neoplasia is high at between 25% and 30%. The most frequently reported malignancies are gonadoblastoma and disgerminoma. We report a case of bilateral gonadoblastoma and dysgerminoma in a female patient with this syndrome.     

Análisis comparativo de dos protocolos de misoprostol en abortos de segundo trimestre de la gestación

Objective

To compare the mean induction-expulsion times in two regimens of vaginal misoprostol for second-trimester pregnancy termination.

Material and methods

We performed a retrospective study of 281 pregnancies between January 2000 and December 2005 (regimen A: 800 μg /24 h) and between June 2007 and December 2008 (regimen B: 400 μg /4 h). Induction-expulsion time was taken as the main outcome.

Results

The mean expulsion time was similar in both regimens (19.7 h for A and 17.7 h for B). No significant differences were found in the expulsion rate at 12, 24 and 48 h. The most commonly observed adverse effect was fever, which was more frequent in regimen B. No major adverse effects such as uterine rupture or severe hemorrhage were observed.

Conclusions

No significant differences were found between regimens A and B in the mean fetal expulsion time, although fever was more common in regimen B.     

Resonancia fetal y síndrome de Currarino

Currarino syndrome is an autosomal dominant partial sacral agenesis involving sacral vertebrae S2 to S5, with preservation of the S1 vertebrae. In the most severe form of the syndrome, the sacral agenesis is associated with a presacral mass and anorectal and urogenital malformations.     

Cribado de aneuploidía en gestación gemelar: resultados de la aplicación del test combinado

Objective

To evaluate the effectiveness of the Combined Test for trisomy 21 screening in twin pregnancies. To assess the performance of biochemical markers and nuchal translucency (NT) measurement in pregnancies with euploid fetuses and in twin pregnancies with one or two affected fetuses. To compare the value of markers according to chorionicity and the mode of conception.

Material and methods

Retrospective study including 161 twin pregnancies. Maternal serum fß-hCG and PAPP-A were determined at 8 to 12 weeks and fetal NT was measured at 11 to 14 weeks. The individual risk of trisomy 21 was calculated in each fetus using the Combined Test. In monochorionic pregnancies, the single risk for the pregnancy was obtained with the largest NT. An invasive diagnostic procedure was offered when the risk was 1:250 or more in one or both of the fetuses.

Results

All trisomy 21 pregnancies were identified (three pregnancies and four fetuses) by the combined testfor a false-positive rate of 6.4% of pregnancies and 3.5% of fetuses. The median fß-hCG level, expressed in MoM, was 1.72 and the median PAPP-A level was 2.01. The median NT was 1.05 MoM. Both fß-hCG and PAPP-A levels were significantly decreased in monochorionic pregnancies and PAPP-A was significantly decreased in pregnancies resulting from assisted reproduction. No significant differences were observed in NT measurement between monochorionic and dichorionic fetuses or between those conceived naturally or by assisted reproduction.

Conclusions

The combined test shows high sensitivity and specificity in screening for trisomy 21 in twin pregnancies. The differences obtained in the biochemical markers according to chorionicity or the mode of conception require confirmation in further studies with a larger number or cases.